The patient was admitted to the hospital with repeated heart fatigue

shortness of breath for 1+ years

and aggravation for 3+ months. Severe aortic regurgitation

mild mitral regurgitation

and infective endocarditis were diagnosed by preoperative TTE. The patient was scheduled for aortic valve replacement. After anesthesia

TEE confirmed the preoperative ultrasound diagnosis again

and the surgeon performed aortic valve replacement under cardiopulmonary bypass. After cardiopulmonary bypass weaning

TEE found a new regurgitation bundle in the anterior mitral valve leaflet

and the vena contracta was 2 mm. The following reasons were considered:1. The possibility of missed diagnosis by preoperative ultrasonography and intraoperative TEE; 2. Suspected iatrogenic mitral valve injury; 3. The mitral valve was not detected during the operation

and it could not be ruled out that hemodynamic instability aggravates valve damage. The surgeon then performed the mitral valve leaflet repair. Postoperative TEE showed no anterior leaflet regurgitation in the mitral valve

and no paravalvular leakage of the aortic valve. The patient was discharged 12 days after the operation.